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DrVirgo
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Answers please.
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| cirus
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1. Acyclovir ( i thought it was mening but the focal neuro & the lymphocytosis made me think of encephalitis, but i'm not sur of this one)
2. Decrease Gag reflex (old age + right lower lobe infilt & reccurence)
3. Sickle cell D ( TMP 3weeks ago in an afric Am & reticul are 15% is SCD (sickling due to stress of Ab) could have been hemolytic if pt had hematuria & jaundice(G6PD))
Edited by cirus on 07/20/07 - 05:57 AM
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| DrVirgo
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1. B. Fungal Meningitis? -cryptococcal Ag is + --> so Amphoteracin?
2. C -decreased gag reflex (agree)
3. D or C? - not sure... It's a normocytic anemia (Normal MCV) with an increased Retic count.
could be Sickle Cell or GI blood loss... ????
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| cirus
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DrVirgo wrote:
1. B. Fungal Meningitis? -cryptococcal Ag is + --> so Amphoteracin?
2. C -decreased gag reflex (agree)
3. D or C? - not sure... It's a normocytic anemia (Normal MCV) with an increased Retic count.
could be Sickle Cell or GI blood loss... ????
For 1 i 'm not sure
3, nothing in the hist or the present suggests blood loss ( flatul, Diarrh, black stool or even the age) if it was an eld, I would have gone for blood loss when my eyes where closed
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| DrVirgo
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black leads me to sickle cell,
BUT chronic blood loss is still the MCC of anemia overall. (menstrual in females and GI in males) so I am stil between those two choices.
waiting for more input. 
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| dr_arc
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antibiotic therapy, G6PDdeficiency exposed to the oxidant stress of tmp-smx and hemolysed.
the history of fatigue dates back to antibiotic use.
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| DrVirgo
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what type of anemia does TMP-SMZ cause?
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| cirus
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I agree that TMP will cause Hemolytic anemia in G6PD but don't u think that he would have had blood in urine, jaundice ( this is an acute hemolytic crises) & I think the complain would have been rather more than just fatigue??
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| elitoki
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1. B
2. C
3. B
TMP-SMX could trigger hemolysis on G6PD pts. Jaundice can be present but not all the time, also depending on severity can present hemolytic crisis.
Ref for G6pd http://www.med.umich.edu/1libr/aha/umg6pd.htm
And I think it could not be sickle cell because pt has 21 yrs old, infection can trigger it but pain is most common symptom and he never had any crisis in his past medical history. (usually begin in childhood after 1yr of age)
In viral meningitis glucose is usually normal(>40mg/dl) and this pt (case 1) has 18 mg/dl.
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| khorshid
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1.B (ampho)
2.C (gag ref)
3.B (G6PD)
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| dr in trouble
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| dr19
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3-B.......G6PD(use of SMX-TMP)
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| DrVirgo
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OK, so final answers:
1. B.
2. C.
3. B.
-explanation for #3: AI or drug induced hemolytic anemia.
Thanks for the explanations.
Edited by DrVirgo on 07/27/07 - 12:38 PM
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| cirus
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ok, i think i got it now so yes the ans is Ab therapy, BUT NOT D T G6PD, Its Auto Immune hemolytic anemia..
this is the expl:
1. TMP/SMZ may cause AI hemol anemia..actually most abs do & I surched the net for TMP/SMZ, it may cause it
2. The increased reticulocutes count also aids this as a mild chronic process, not acute as G6PD
plz comment
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| cirus
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Anyone??
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| manolok
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B
C
B if they patient is black with anemia you should consider either sickle or G6PD. the px's history of tmp-smx=sulfa set off the anemia coz it caused oxidant stress and lead to the anemia.
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| DrVirgo
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They didn't mention anything specific about sickle cell or G6PD, so I guess you can't really assume they have it just because they are black.
What we DO know is that he took TMP-SMZ. So this is most likely Autoimmune Hemolytic or Drug Induced Hemolytic Anemia due to a sulfa drug.
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